Canada’s health-care system is failing people who need mental-health care

The revelation that a Supreme Court of Canada justice has suffered for 20 years from depression and anxiety disorders has one bright side.

Clément Gascon’s plight is, of course, terribly sad. The 59-year-old justice announced last month that he will be stepping down from the highest court for personal and family reasons in September.

But from the perspective of those seeking to destigmatize mental illness, his example is proof that it can hit anyone – and that those affected can also function at the highest levels, in jobs demanding tremendous concentration, discretion and discipline.

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Just as heartening is the court’s acceptance of Justice Gascon in the wake of his public admission this week about his health, and that a panic attack brought about by a change in medication was the reason he went missing for several hours on May 8.

Rather than force him off the bench, as the Supreme Court did to a justice in 1988 after he was hospitalized for depression, the current Chief Justice, Richard Wagner, said that he and his colleagues “are very proud of Justice Gascon, and he has my full support and confidence. I look forward to seeing him back on the bench.”

The Supreme Court’s enlightened response is part of a general improvement in society’s acceptance of mental illness as a legitimate ailment that shouldn’t be stigmatized.

But Justice Gascon’s story has darker side. It is a reminder that Canada is still failing people by not providing proper treatment for illnesses that are no less real than breaking a leg, and no less debilitating than cancer.

After all, if someone at the top of Canadian society in terms of education, income and access to health care struggles with an “insidious illness,” as Justice Gascon put it, what does that say about the plight of the average person?

We already know the answer. A 2016 joint statement on access to mental-health care from the Canadian Medical Association and Canadian Psychiatric Association estimated that, of the 20 per cent of Canadians who suffer from a disorder, fewer than one in three will seek treatment.

The reasons for this are many, but chief among them is the fact that, as the Canadian Mental Health Association (CMHA) says, “evidence-based health care provided by addiction counsellors, psychologists, social workers and specialized peer support workers” is generally not covered by medicare.

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That leaves Canadians reliant on their family doctor as a portal to care when they suffer from depression, anxiety, addiction and other afflictions. In many cases, the best a general practitioner can do is provide a patient with a list of phone numbers or e-mail addresses for clinics and private practitioners, all of whom work in their own silos and offer an array of therapies that are confusing to the layperson.

And even when patients find a promising health practitioner, they discover waiting lists as long as a year for sessions during off-work hours, such as the evening, forcing them to choose between their jobs and getting the help they require.

Many who are uninsured also discover they cannot afford long-term therapy that costs at least $80 an hour, and which can run as much as $250 an hour or more.

Even mental illnesses that require hospitalization, and are therefore covered by medicare, are treated differently than physical ones. According to Health Quality Ontario, which monitors health care in Canada’s biggest province, only one in three patients discharged from a psychiatric ward has a follow-up appointment within a month, compared to 100 per cent of patients discharged after a heart attack.

As a result of such inconsistent care, “many people with complex or chronic mental health problems … end up cycling through the acute-care system,” the CMHA says.

That same cycling occurs in Canadian prisons, where inmates with mental illnesses are left untreated – or, worse, have their symptoms exacerbated by being put in solitary confinement. Both approaches make it less likely they will recover, and more likely they will reoffend.

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Until Ottawa and the provinces treat mental illnesses as they do physical ones – with readily available, continuing and cost-free care – Canadians will suffer needlessly.

It’s all well and good that the stigma of mental illness is fading. But even as the taboo against asking for help disappears, barriers in our health-care system still prevent many Canadians from getting the treatment they need.

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